This illustrates further that PID are not diseases affecting children only and that the find more awareness for adult presentations of these diseases is increasing. In

some of our contributing centres, adults are treated in paediatrics departments because there is no expertise in internal medicine departments. This is an issue that certainly still needs to be given more attention from policy makers, and our observations should help to bring this issue on the agenda. The genetic basis of their disease remains undefined for a large number of patients, especially for those with antibody deficiencies. The gender distribution shows that males were affected much more frequently by PID than females. Interestingly, in patients younger than 30 years, boys are

affected more frequently even if X-linked diseases selleck products are excluded. A specific example for this was recently given in autoimmune lymphoproliferative syndrome (ALPS) [20]. The reason for this is unknown, but may reflect additional genetic susceptibility factors encoded on the Y-chromosome. We further observed that among patients older than 30 years, more women than men are affected by a PID. We have no explanation for this. Another important issue is the diagnostic delay which is a marker for the improvement of awareness of PID. This is especially true in PID that present less severely and may go undiagnosed for many years, such as CVID. We were able to identify positive overall trends towards a shorter diagnosis for agammaglobulinaemias and IgG subclass deficiency. Conversely, CVID in particular continues to present with a very high median diagnostic delay of 3 years in many patients who receive Meloxicam their diagnosis more than 10 or even 20 years after disease onset. The documentation progress of the ESID database has made it the largest single collection of PID patient data to date. The more countries manage to organize a complete coverage

of PID documentation on the national level, the better we can judge the meaning of numbers produced by the ESID database. In a survey among the database users conducted from July to September 2010, we tried to determine how the system could be made more user-friendly in order to increase reporting. Major issues we identified were slow loading of the web pages and the complicated structure of the system, with more than 210 disease entities. We addressed these issues by upgrading to new hardware and restructuring the data entry system, which led to a reduction to 138 entities. Conversely, we also realized that our current core data set is obviously too complex and unfocused, because for many patients large parts remain undocumented. Therefore, we decided to define a new, more focused core data set which will be discussed by representatives of all national registries in Freiburg in December 2011.